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Sierra Leone: How not to milk Ebola

by / Comments Off / 238 View / 5th August 2014

The outbreak of Ebola in West Africa has raised a number of issues, and also highlighted the deficiencies in Sierra Leone’s healthcare, and public health infrastructures.  It has also emphasised how such emotive issues can provide opportunities for people to exploit situations to their advantage, and thus milk the Ebola.   Let us consider the facts of the virus and the issues that it raises.

We know that although there is as yet no vaccine to cure Ebola, it is treatable.  The main symptoms of the disease begin as weakness, muscle pain and fever and may develop into vomiting, diahhorea, difficulty breathing and swallowing, and bleeding both inside and outside the body.   Dr Phillipa Cheetham, from Winthrop-University Hospital, in New York, USA said that the main treatment is supportive care, as with any usual influenza, and the important factors seem to be about providing fluids and electrolytes, keeping blood pressure stable and providing oxygen. Sounds basic, but, it can help to improve the chances of recovery.   In spite of this, however, a large number of patients still die from the disease; estimated about 60% from the current strain of the virus, but this can be improved on with early and appropriate treatment.

Hence, the Ebola virus exposes the serious deficiencies within Sierra Leone’s health care delivery sector; lack of basic hygiene, clean water supply, lack of health workers and medical professionals etc.  And this goes way beyond the current government.  Given that preventative measures such as washing hands regularly, and having clean water, good waste management procedures, can have a beneficial effect on reducing the spread of the disease, this again highlights the problems in Sierra Leone, where these basic procedures are more of a challenge.  Once the current outbreak is contained, it will be important to look at these more underlying issues, and how people can take better care of themselves and improving public health in general.

Since the beginning of the outbreak hundreds of international aid workers and over a hundred WHO staff have been deployed overall to the region of West Africa affected, to help treat the infected patients.    Sierra Leoneans are used to having to bring in meals and even basic medical equipment to their loved ones in hospital that the health care system cannot often provide due to financial constraints.  This not only adds to the pressure of treating a large number of very ill people, but also adds to the emotional burden on families giving up their loved ones to what must be terrifying isolation units where healthcare workers are wearing astronaut type outfits, where people go and never return.  Even their loved one’s burial is likely to be managed by a specialist team.  Thus it should be noted that the mistrust and suspicion with which health care workers are treated is also adding to the problems of tackling Ebola within tightly knit communities in Sierra Leone, as families would prefer to nurse their sick at home, which adds to the risk of the virus spreading.

What is notable is the reaction from Western nations, that there is no way the disease can spread there, due to the sophistication of the health care systems in place.  This was highlighted further by an emergency meeting held in the UK, to consider the threat of the Ebola virus.  The view expressed by the Foreign affairs minister Phillip Hammond, following the meeting, was that the main threat in the UK was about someone becoming unwell once returning to the UK from the affected region, and not about the spread of the disease in the UK, because, “we have frankly different standards of infection control procedures that would make that most unlikely,” he said   This is evident in the transportation of Dr Kent Brantly, a doctor who contracted the illness whilst working in Liberia.  He was carried in a specially kitted plane, containing an isolation tent, back to the US, and then in a similarly resourced ambulance to an isolation unit in Atlanta.  It is clear here that the measures taken are so comprehensive that the spread of the virus is virtually impossible.  It should be noted also, however, that the international community often make this statement almost as an afterthought, with the main headlines being more panic inducing.  This therefore initially suggests that Ebola is a very worrying threat, when the reality is that this threat can be contained through basic protection and care in developed countries with adequate medical resources.

But managing Ebola is not just about resources, and standards of hygiene, it is also about how the available resources can best be co-ordinated to deal with the outbreak most effectively.  It is normal when disaster strikes to pull together, putting aside all differences to deal with the problem.  There are more chances of success with this approach.  Therefore, Sierra Leoneans should set aside political differences and economic survival instincts, and work together to eradicate the deadly virus.   Since President Ernest Bai Koroma declared a state of public health emergency in the country, greater effort has been made to do this – even though the country is not there yet.  In those early stages, and even now people are working on different tangents, criticising each other and becoming ‘doctors’ and ‘philanthropists’ in their own rights, creating a divided fight which will not hasten the process of combating the outbreak.

For instance, incessant criticism of the Ministry of Health by the Special Executive Assistant to the President, while still in government opened the floodgates for everyone with a bone to pick with government to do so using the Ebola excuse. Baroness Sayeeda Warsi, the British Foreign Office minister resigned only yesterday from Prime Minister David Cameron’s government for what she termed the UK’s “morally indefensible” position on the conflict in Gaza. This shows that when there is a clear cut disagreement with one’s own government – where collective responsibility is the watchword – the principled thing to do as a government official is to resign.  The mind boggles that only in Sierra Leone can one stay in government and criticise that selfsame government publicly.  The business community are also taking advantage of the situation, using Ebola to have photo ops with the President.  The opposition party, too, are looking at it as a way to beat and find fault with the government, when in fact the problems with the health care system were already evident before the current government took power.  Organisations such as those in the NGO and Church community are soliciting and having funds donated to them directly, and using those funds to help people in their own way, where a co-ordinated effort would be more successful.

What is needed now in order to take things forward is some clear and decisive leadership through the lead ministry – Health – which will help things to be co-ordinated from one channel, with a common purpose of tackling the outbreak in a coherent and effective way.  Since declaring a state of emergency at the end of July, President Koroma has brought in the police and military to help isolate the epicentres of the illness, and give protection to health care workers so they can carry out their work uninterrupted.  They have also been given powers to knock on doors, hunting for people who may be afflicted with the deadly virus.  However, we should be cautious about giving the security forces carte blanche to move people around.  This was a feature of the 11-year- war, when security forces used their powers to settle scores and treat people unfairly given rise to their disbandment by President Ahmad Tejan Kabbah.  Measured and balanced approach and good accountability are therefore needed to ensure that the security forces are working in the interests of the citizens of Sierra Leone.

A meeting held in Accra, Ghana early July involving health ministers from 11 African countries highlighted the various issues which needed to be addressed in order to co-ordinate a more effective response to the Ebola outbreak, across the whole region.   They cited issues with coordination, and communications, as well as cross-border collaboration, treatment of patients, contact tracing and community participation, human resources and financial support.  As a result of this meeting, a Sub-regional Outbreak Co-ordination Centre has been set up in Guinea, by the World Health Organisation (WHO) to help co-ordinate the technical support offered to countries affected, and also mobilise the resources to the areas where they are needed.  This can only help provide the necessary leadership and co-ordinated response needed to address the threat of this deadly disease.

Dr. Margaret Chan WHO Director General said in a speech that the consequence could be ‘catastrophic’ if the disease continues to spread and announced that a WHO Emergency Committee meeting will be held in Geneva, where WHO officials will decide then whether to declare the outbreak a “public health emergency of international concern.” Chan made a point of telling the West African presidents that they are not alone in their fight against Ebola; that the world is with them.  So it seems that in part the international community is forcing the agenda of collaboration, to reinforce the recent actions of President Koroma.  So it is hoped that the criticising government officials, the keen businessmen and the numerous NGO’s, and others in positions of influence, will be guided to continue to work collaboratively, and not milk the Ebola any longer.

 

Picture credit:  bbc.co.uk